Provider Demographics
NPI:1861573875
Name:DEL RIO THERAPY, P.C.
Entity type:Organization
Organization Name:DEL RIO THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TICE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:956-428-2512
Mailing Address - Street 1:PO BOX 532047
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2047
Mailing Address - Country:US
Mailing Address - Phone:956-428-2512
Mailing Address - Fax:956-428-0232
Practice Address - Street 1:2201 N BEDELL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8020
Practice Address - Country:US
Practice Address - Phone:830-775-9118
Practice Address - Fax:830-775-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225200000X, 235Z00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184572901Medicaid
TX184572901Medicaid